Provider Demographics
NPI:1770069627
Name:MORAN, PAUL (RPH)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:MORAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 KINGS VILLAGE
Mailing Address - Street 2:
Mailing Address - City:MINERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17954
Mailing Address - Country:US
Mailing Address - Phone:570-544-8290
Mailing Address - Fax:
Practice Address - Street 1:44 KINGS VLG
Practice Address - Street 2:
Practice Address - City:MINERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17954-1902
Practice Address - Country:US
Practice Address - Phone:570-544-8290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP004281L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist